Why is this study important?

Angiography after coronary artery bypass surgery (CABG) is often required but can be more challenging with a higher complication rate and longer procedure times as the location of bypass graft ostia is variable. Prior observational data suggested the benefit of using coronary computed tomography (CTCA) to improve outcomes in those patients. BYPASS-CTCA is the first study to provide high quality evidence to help answer the question: Does CTCA prior to planned angiography improve procedure metrics or patient outcomes?  

What did the study show?

The use of CTCA prior to angiography in patients with CABG significantly reduced procedure time, procedure related complications and resulted in higher patient satisfaction.  

Should I change my practice because of these findings?  

Yes! The study results support more adaptation of CTCA prior to angiography in patients with CABG, especially in cases of unknown bypass anatomy and multiple patient co-morbidities. 

How good was the approach/methodology?

BYPASS-CTCA randomized 688 patients with prior CABG undergoing angiography to CTCA prior to angiography or angiography alone. It is a single center well-designed randomized clinical trial. It is worth noting that procedure times and rates of acute kidney injury in the angiography only group were higher than average when compared to some national catheterization databases. Also importantly, the interpretation and application of information from CTCA is currently still variable amongst clinicians and centers. It remains to be seen if the study results apply in large populations, diverse practice settings and multiple centers.  

All editors: Luai K. Tabaza, MD, FSCAI